The 2004 Marshall Urist Award - Delays until surgery after hip fracture increases mortality
The 2004 Marshall Urist Award - Delays until surgery after hip fracture increases mortality
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DOI：
10.1097/01.blo.0000146743.28925.1c
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发表时间：
2004-11-01
影响因子：
4.2
通讯作者：
Silber, JH
中科院分区：
文献类型：
--
作者：
McGuire, KJ;Bernstein, J;Silber, JH
本研究的目的是分析从入院到手术治疗的时间延迟是否会增加闭合性髋部骨折患者的死亡率。我们使用入院的一周的一天作为一个工具变量来伪随机化患者。我们分析了18,209名65岁或以上的医疗保险接受者，他们因闭合性髋部骨折接受了手术治疗。入院和手术之间延迟2天或更长时间的患者在第30天死亡的可能性高出17%。使用工具变量分析，我们发现延迟手术2天或更长时间的患者死亡风险增加了15%。基于这些结果，我们发现延迟2天或更长时间会显著增加死亡率。这表明手术延迟独立影响死亡率，因此需要对较小延迟对结局的影响进行额外研究。
The objective of this study was to analyze whether a delay in time from admission until surgical treatment increased the mortality rate for patients with a closed hip fracture. We used the day of the week of admission as an instrumental variable to pseudorandomize patients. We analyzed 18,209 Medicare recipients who were 65 years of age or older and had surgical treatment for a closed hip fracture. Patients for whom the delay between admission and surgery was 2 days or more had a 17% higher chance of dying by Day 30. Using instrumental variables analysis, we found a similar 15% increased risk of mortality in patients with delays until surgery of 2 or more days. Based on these results, we found that a delay of 2 or more days significantly increased the mortality rate. This suggests that delay to surgery independently affects mortality, therefore additional study on the effect of smaller delays on outcome is needed.